title: Clinical and proctoscopic evaluation of topical formalin application in the treatment of chronic radiation proctitis.
abstract: OBJECTIVE
  Chronic radiation proctitis is a disease associated with radiotherapy of cancer in the pelvic region. The main symptom is rectal bleeding. Several treatment modalities have been attempted, but few have demonstrated satisfactory effects. We present our experience with formalin applied locally to the rectal mucosa in the treatment of chronic radiation proctitis. Furthermore, we assess possible complications, the gravest suggested being cancer. Previous studies on the subject have reported good results, but often with a somewhat vaguely defined follow-up. Our evaluation of the treatment was based on both subjective symptoms and proctoscopic findings.
  
  
  METHODS
  A small study (N = 11) was conducted retrospectively. All patients treated for chronic radiation proctitis with formalin in our clinic were identified, and data concerning effect and complications were collected by studying the patients' records, with a questionnaire and a follow-up interview and proctoscopy.
  
  
  RESULTS
  The study showed a marked decrease in bleeding and objective signs of proctitis in all patients. Complete cessation of bleeding was achieved in five patients. Possible complications to the treatment detected in our study were the following: anorectal pain, tenesmus, incontinence, diarrhea, and mucous rectal discharge. No signs of neoplasia were found.
  
  
  CONCLUSIONS
  The formalin treatment had a very good effect on chronic radiation proctitis. Possible complications were detected. Except in the case of anorectal pain, these are all of a questionable nature and can possibly be attributed to chronic radiation proctitis itself rather than the formalin treatment. Further study is warranted to confirm long-term effects of the formalin and to exclude possible complications, especially secondary anorectal cancer.
authors.affiliation: Abdominal Surgery Ward (Department P), Aarhus University Hospital, Aarhus, Denmark.
authors.forename: P L
authors.initials: PL
authors.lastname: Eriksen
authors.forename: R S
authors.initials: RS
authors.lastname: Tougaard
authors.forename: A
authors.initials: A
authors.lastname: Tøttrup
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde / Q000627:therapeutic use*; D006801:Humans; D007413:Intestinal Mucosa / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000188:drug therapy* / Q000209:etiology; D011351:Proctoscopy; D011832:Radiation Injuries / Q000188:drug therapy* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D012007:Rectum / Q000528:radiation effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005557:Formaldehyde
keywords: Radiation; bleeding; cancer; formalin; proctitis; proctoscopy